Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees. I wrote about the August 2016 report back on 11/20, and normally would be writing about the September report today. Instead, however, I'm skipping right past September, because the preliminary report for October was just released today:

UPDATE: Denis Byron, in the comments below, claims that Ryan Cooper's story (and therefore, mine) is "incredibly deceptive" and that I should be "ashamed" of myself for basing this entry on it. I've contacted Cooper about Byron's claims and will update the article if Cooper responds. Byron is correct that I am by no means a Medicare expert, so I'll leave it at that for the moment.

UPDATE 12/31: A few folks in the comments have noted that a) pre-existing condition denials aren't an issue for most group policies even without the ACA and b) some of the professions listed below don't appear to belong on the list since those groups should be guaranteed coverage anyway (ie, the VA/TriCare for those in the military; members of police/firefighter unions and so on). Both KFF and I have already addressed the first point (yes, they're covered now but if they lose their job for any reason they'd likely be screwed; thus, the "...if they were to lose their current coverage" caveat). As for the second one, I've asked Larry Levitt & Cynthia Cox of the KFF to clarify.

Update 12/31: I've received clarification from Larry Levitt re. the 2nd criticism: "I suspect insurers were mostly being overly cautious just in case. Active duty military would be covered otherwise. Police and fire generally would, but possibly not in small towns or volunteer firefighters."

Remember, the ACA's Medical Loss Ratio rule (80% of all premiums have to go towards actual healthcare, leaving only a 20% maximum margin for administrative/operational costs) already does a pretty good job of keeping carriers from outright gouging enrollees...although that only comes into play when the carriers would otherwise be spending less than 80% on healthcare claims. In cases where they're already spending more than 80%, it's kind of moot...and for the past couple of years, many carriers are at 100% or higher, which is the main reason some of them are pulling out of the market next year in the first place.

In other words, unlike other "retail" markets where more competition is generally considered to automatically help keep prices down, there's only so much that more players can do in the individual health insurance market. If everyone is already losing money, adding one more to the mix isn't gonna make anyone else drop their rates further.

I just noted this morning that Rhode Island's enrollment numbers for 2017 are coming up significantly short of not only my own admittedly unrealistic hopes (I was hoping RI would buck the national trend and beef up enrollment by 15% this year), but is likely to actually come up lower than last year's 33.9K by several thousand people.

Fortunately, the opposite is proving to be the case in Massachusetts:

Through yesterday, we had 240,745 enrolled in January 2017 coverage...these are people who paid their bill. There are an additional 11,803 people who selected a plan but haven't paid for it yet. That's a total of 252,548.

That's, 252,548 QHP selections as of 12/28/16, of which over 95% have actually paid their first monthly premium (well above the 90% payment national average).

Rhode Island is one of three states (along with Washington and Massachusetts) which allowed people to enroll for January coverage as late as December 23rd. RI's numbers have also included auto-renewals for some time now, so today's report includes everyone whose 2017 policies will kick off effective this Sunday, January 1st:

Oof. I've been compiling a lot of charts and graphs the past week or so based on what I thought were the most comprehensive 2017 enrollment numbers available to date. The biggest data gaps are Vermont and New York, neither of which has released any enrollment data yet...or so I thought.

In the past three days, more than 55,000 New Yorkers have enrolled or renewed coverage through NY State of Health. The Customer Service Center has answered more than 1,000,000 calls since the start of Open Enrollment on November 1 and an average of 46,000 calls a day this week. The NY State of Health website has also experienced high traffic reaching 12,000 users in peak hours.

...This is also the first time this enrollment period that NYSoH has released any actual enrollment data: 55,000 renewals + new signups. Unfortunately, that number only includes 12/12 - 12/14...no earlier numbers are included. Still, I'll take what I can get...

Access Health CT, the organization responsible for enrolling people in Obamacare, did not release numbers on how many people are enrolled in policies that take effect Jan. 1. Instead, they released a combined number of who's enrolled now and who will be enrolled next year: 113,161.

...Access Health CT noted that nearly 12,000 people who are currently enrolled are in plans that will not exist next year and are therefore not covered. They can still re-enroll, but they'll have a gap in coverage in January.

At this point in 2015, 100,314 people were scheduled to have Obamacare insurance coverage on Jan. 1, 2016.

With the HHS Dept. having just released the total number of 2017 Open Enrollment Period enrollees through the extended December deadline, I've been seeing a lot of comments on Twitter along the following:

There could be a light at the end of a dark tunnel for Obamacare insurers.

Health insurers may finally be seeing improved results on their Obamacare plans just as a newly elected president is poised to follow through on promises to end the controversial coverage program, a new report suggests.

An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.

And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.

The report also says big price increases for Obamacare plans in 2017 were likely a "one-time pricing correction."

I did this for the heck of it back in 2015 and it's become sort of an annual tradition for me. On the one hand, with the 4th year added this layout is starting to get too confusing. On the other hand, it's looking very much like this will be the final year of ACA open enrollment anyway, so I guess that's a moot point.

It's important to bear in mind that the first Open Enrollment Period (for 2014 coverage) lasted a whopping six months...and even that was extended by 15 days due to the massive technical problems during the October 2013 launch period. Technically speaking, the 2014 open enrollment period lasted a total of 197 days, which has been time-compressed so the starting and ending dates match the other three years. That 15-day extension is also why the first big "surge" appears to come earlier on the graph than it actually did--it's been "pushed back" a bit.

As noted in my "Week 7 Plus" December Deadline Snapshot Report write-up, along with the updated State-by-State write-up, while I was dead on target in predicting enrollments up through the original 12/15 deadline at HC.gov, I seriously overestimated the additions who signed up during the 4-day "extension period". I figured it'd be anywhere from 750K - 1.0M; instead it was just 350,000 or so. However, since there are still several million auto-renewals left to be added to the mix, this doesn't necessarily mean anything; it could simply be a half-million or so more auto-renewals instead of active renewals will be added later this week.

I've confirmed 8.8 million QHP selections nationally to date. That leaves almost exactly 5.0 million more enrollees needed to reach this year's target of 13.8 million by January 31st. A pretty tall order, but we can cut that down to size:

IMPORTANT: The total enrollment numbers for the 39 HC.gov states are quite a bit behind last year. However, this is mainly because auto-renewals haven't been added to the totals yet for those 39 states yet. This makes it impossible to do an apples-to-apples comparison vs. last year for those states.

Since auto-renewals have already been added to most of the state-based exchange numbers but not to the federal exchange numbers, it gets a little tricky to visualize. The blue sections show how far ahead 11 states are based on their status. I'd expect any state which has already added in their auto-renewals to have reached around 85% of my final target, while those which haven't added them to the tally should only be at around 65%.

Today, as part of a deadline reminder press release (WA is among 3 states which are still letting people sign up for January coverage as late as midnight Friday), they gave a rough update:

The Washington Health Benefit Exchange today is warning customers without 2017 coverage that this Friday, Dec. 23 at 11:59 p.m. is the deadline to sign up for health and dental plans through Washington Healthplanfinder that begin on Jan. 1.

OK, for the first time this Open Enrollment Period, my expections were off base...significantly. The past two years, HHS was posting "weekly snapshot" reports of enrollments at the federal exchange (HC.gov). This year they switched to 2-week reports, but today they decided to issue a special "week-plus" version which covers enrollments through the (extended) 12/19 deadline for coverage starting January 1st.

As I noted last Friday, based on the massive surge in enrollments (a record-breaking 670,000 people) on the final original deadline day (12/15), I bumped up my estimates for the 4-day extension period from my original 6 million or so up to an even 7 million (assuming 250K/day). However, I later realized that two of those days fell over the weekend, when enrollments drop off substantially (and since the original deadline had already passed, even the extended deadline wouldn't make much difference weekend-wise). I pulled back my projection somewhat to 6.75 million.

However, it turns out I was still overestimating, although the numbers are still pretty impressive:

Last week, the Rhode Island exchange reported 27,555 QHP enrollees as of 12/10, a tiny increase over the prior week mainly due to auto-renewed enrollees dropping out, cancelling out most of the increase.

Donald Trump's campaign and its supporters spent a good portion of the 2016 campaign arguing that Hillary Clinton was secretly very ill and not up to the task of being president.

Trump's doctor, by contrast, isn't too worried about his patient dying in office — at least, not when it comes to the future of the country.

“If something happens to him, then it happens to him,” Harold Bornstein says. “It’s like all the rest of us, no? That’s why we have a vice president and a speaker of the House and a whole line of people. They can just keep dying.”

BRILLIANT!

Why didn't anyone else ever think of this? No need to worry about "going to the doctor" or "receiving medical care"...it's much easier and more cost-effective for all of us to simply die!

If you're married or have children, no worries; you'll have a whole line of successors to pick up where you left off!

...HOWEVER, their bosses...the HHS Secretary and, I presume, the head of CMS...will be appointed by Donald J. Trump and confirmed by a 100% Republican-controlled Senate.

Given Trump's long, disturbing history of flat-out misstatements (aka "making sh*t up out of whole cloth"), and the type of sycophants he's likely to put into place, I can't guarantee with 100% certainty that the numbers spouted off by them are going to bear any connection with reality. Maybe they'll be accurate. Maybe they'll be off slightly. Maybe they'll be completely removed from any actual numbers. Who the hell knows?

Earlier today it was reported that Ben Carson was being considered for HHS Secretary. Then the rumor mill turned to Bobby Jindal. At the moment, I'm hearing it could be Rep. Tom Price, who (like pretty much every other GOP member of Congress) despises the ACA. That doesn't guarantee that he'll Make Sh*t Up, of course, but under a Trump regime, anything's possible. Anything.

I noted a couple of weeks ago that Massachusetts has a unique methodology for reporting their ACA exchange enrollments. For one thing, they only officially count people who sign up for policies as "enrollees" after they've made their first monthly premium payment. In addition, like some other state exchanges, they "pre-renew" their current enrollees before the December deadline, and then reduce the official number from there as some people choose not to renew their coverage. As a result, instead of their "QHP selection" tally increasing, it actually starts out huge and then drops a bit as the enrollment period continues.

As a result, instead of 260,275 QHP selections, their number is a bit lower today:

Through Sunday, the 18th: 224,211 2017 enrollments. Plus, an additional 26,868 plans selected but unpaid at this point.

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.

BOISE, Idaho - Early enrollment numbers show a record number of Idahoans are enrolling for health insurance through the state-based health insurance exchange, Your Health Idaho. Over 98,000 Idahoans have selected a 2017 health insurance plan since open enrollment began on November 1, 2016. The numbers were announced at today's board of directors' meeting.

Nearly 85 percent of Idahoans currently enrolled in a plan on the exchange receive a tax credit to help offset monthly premium costs. Your Health Idaho is the only place in the state offering individuals premium tax credits.

DENVER — More than 144,000 Coloradans selected healthcare coverage for 2017 through the state health insurance Marketplace through Sunday, December 18, a rate 18 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®.

“We have seen a definite increase in the pace of sign-ups during the first half of this Open Enrollment period,” said Connect for Health Colorado CEO Kevin Patterson. “These Coloradans have protected their health and their finances with healthcare coverage next year. I encourage anyone who does not yet have health insurance for 2017 to go to our site, Connectforhealthco.com, check to see if they qualify for financial assistance, review the available plans, and complete an enrollment. They can have coverage in place February 1 if they act by January 15.”

This Just In...(Minnesota was one of the few states which stuck with the original 12/15 deadline for January coverage):

ST. PAUL, Minn.— MNsure has enrolled 54,586 Minnesotans in private health care coverage, far outpacing the approximately 27,000 who had enrolled at a similar stage of open enrollment last year.

Additionally, since the start of open enrollment, 14,020 Minnesotans have eligibility determinations in MinnesotaCare and 43,327 in Medical Assistance.

The 2015-2016 open enrollment period set a record for the most Minnesotans enrolled in private health plans, but the 2016-2017 period has been even more brisk. By December 28, 2015, the deadline for January 1 enrollment last year, about 27,000 had enrolled, meaning enrollment numbers are twice what they were at the same time last year.

"You got to have some insurance. They shouldn't even call it insurance. They just should call it ''in case shit.'' l give a company some money in case shit happens.

... That's right, man, you better have some medical insurance, or you gonna die. That's right, everybody. You got to eat right and exercise. No, you don't, you need some coverage. Coverage will save your life. That's right, we all gonna die, but at least if you got some coverage... you will die on a mattress. That's right.

Avatar: The Last Airbender takes place in a world that is home to humans and hybrid animals, adjacent to a parallel Spirit World. Human civilization is divided into four nations: the Water Tribes, the Earth Kingdom, the Fire Nation, and the Air Nomads. Each has a distinct society, wherein people known as "benders" have the ability to manipulate and control the element of their nation using the physical motions of martial arts. The show's creators based each bending style on an existing Chinese martial art, leading to clear visual and physical differences in the techniques used by Waterbenders (tai chi), Earthbenders (Hung Ga kung fu), Firebenders (Northern Shaolin kung fu) and Airbenders (Baguazhang).

...At any given time, only one person in the world is capable of bending all four elements: the Avatar, who serves as an international arbiter. When the Avatar dies, the Avatar spirit is reincarnated into the next one of the four nations in the Avatar Cycle: the Fire Nation, Air Nomads, Water Tribe, Earth Kingdom, in order.

Last February I was invited to join Will McLeoad & Arliss Bunny on their "I'm Hopping Mad!" podcast to discuss the heated debate over single payer healthcare vs. a more incrementalist approach.

Over this past weekend, Will and Arliss invited me back to discuss the GOP's impending ACA "repeal/replace" intentions, why pretty much all of them would be a disaster and other items. This episode opens with a great explainer/discussion of the "Fake News" debacle; my own segment starts at around 28 minutes in.

I made my original 2017 Open Enrollment Period projections before November 1st, and have only made a couple of modifications to The Graph since then...mainly to account for the fact that the 1st fell on a Tuesday this year instead of a Sunday. None of this changed my final projection of around 13.8 million QHP selections nationally by the end of OE4 on January 31, 2017.

In fact, the only time I seriously considered changing my final projection was November 9th, when I briefly speculated that Donald Trump's election could cause a disastrous drop-off in enrollments, flatlining at perhaps 1.5 million total. This particular concern was, fortunately, unfounded, as it turned out that not only did enrollments end up pacing my projections almost pefectly, they were actually running slightly ahead of my expectations overall.

We did it! We met the very important December 15 deadline with positive energy and in my opinion, we knocked it out of the park! We’ve seen some very impressive numbers with 10,000 plan selections on Wednesday. And on Thursday we processed more than 12,000 plan selections! Thank you for your tireless efforts supporting our customers.

With the volume that we are seeing, we want to reiterate that we are committed to assisting customers with January 1 coverage who began the process by midnight December 15. If customers are delayed, they should call our Customer Service Center for assistance before finalizing their enrollment. Our established process for requesting an alternative start date can be used to facilitate this.

HC.gov's one-day enrollment record was set exactly a year ago today (12/15/15), when they enrolled 600,000 people in a single 24-hour period. I've been assuming that fewer people would enroll today specifically this year, if only because so many current enrollees have been actively renewing earlier than in the past; I figured this would've taken some of the heat off of the final day, so I knocked 10% off of the top.

Instead, it looks like I may have underestimated today's haul. The federal exchange could conceivably hit 700K today, and the national tally could potentially hit 800K or so. Then again, if they announce a deadline extension, some of that might spill over into the weekend.

Consumers now have through midnight on Monday, Dec. 19 to sign up and have their coverage begin starting Jan. 1.

More than 67,000 new consumers selected a plan during the past four days.

SACRAMENTO, Calif. — Covered California is extending a key enrollment deadline for coverage starting Jan. 1 in order to align with a new federal announcement made yesterday that extends the deadline for HealthCare.gov states.

Consumers enrolling through Covered California will now have through Monday, Dec. 19 at midnight to sign up for health care coverage that will begin on Jan. 1.

Covered California hopes that by aligning the deadline with HealthCare.gov it will reduce any confusion that consumers may experience after hearing yesterday’s federal announcement, and give consumers the time they need to sign up for coverage.

Just to clarify, I fully realize that Disney/LucasFilm would've had to agree to such an official ad campaign.
I'm assuming that it's OK for me to do this under parody/fair use.
Images will be removed if requested. Please don't sue.

3/22/17: Now that the GOP is apparently going to try and cram through killing off Essential Health Benefits and so forth in the #Trumpcare bill after all, it seems like a good time to repost this.

For years now, the Holy Grail of healthcare policy for progressives has been Universal Coverage (UC): Every single person receiving guaranteed, comprehensive, quality, affordable healthcare coverage. For most progressives, the means for paying for universal coverage is envisioned as a Single Payer (SP) system...which simply means that people pay taxes to the federal government, which in turn pays the medical bills to doctors, hospitals and other healthcare providers (note that neither UC nor SP have anything to do with Socialized Medicine (SM), in which all of the doctors/hospitals work for & are controlled directly by the government).

“Millions of Americans have already signed up for coverage and tens of thousands more are in the process of getting coverage today. As we did last year, because of extraordinary volume of consumers contacting our call center or visiting HealthCare.gov, we are extending the deadline to sign-up for January 1 coverage until 11:59pm PST December 19. Nearly a million consumers have left their contact information to hold their place in line. Our goal is to provide affordable coverage to everyone seeking it before the deadline, and these two additional business days will give consumers an opportunity to come back and complete their enrollment for January 1 coverage.”

UPDATE: OK, I've confirmed that this is in fact a full 4-day deadline extension, so anyone can still sign up by Monday at midnight.

As I said a little while ago, until yesterday, I honestly wasn't expecting any of the exchanges to deviate from their official enrollment deadlines this year. Each year there've been fewer and fewer extensions, "overtime periods" and so forth allowed, as more and more people get used to how the system works and especially as the exchange websites become more streamlined & less buggy, with beefed-up sever capacity and so forth.

NY State of Health Deadline Extended! New Yorkers Now Have Until December 17 to Enroll in or Renew Health Insurance Coverage Beginning January 1, 2017

High Enrollment Activity Prompts Deadline Extension

ALBANY, N.Y. (December 15, 2016) - NY State of Health, the state’s official health plan Marketplace today announced that the deadline to enroll or renew coverage for a health plan effective January 1 has been extended through December 17. The previous deadline was December 15. Consumers have two additional days to enroll in a plan with coverage starting January 1.

“NY State of Health is having the busiest open enrollment period yet and we want consumers to have a little more time to select a health plan for January 1, 2017.” said NY State of Health Executive Director, Donna Frescatore.

I'm genuinely surprised by this. While deadline extensions and "overtime periods" were all the rage during the first two Open Enrollment Periods, there were only a handful of states which bumped their deadlines out last year, and I was honestly expecting every state to stick with their original dates this time around.

I've noted several times that while the total enrollments so far have been tracking my pre-election projections almost perfectly, the drop-off in new enrollments suggest potential trouble ahead. That is, the main reason the overall enrollment numbers are at or even ahead of my expectations so far is because more current enrollees are actively renewing their policies earlier, cancelling out the smaller number of new enrollees signing up. Obviously once those current renewals dry up (which will mostly happen this week), the rest of the enrollment period can't count on that any further.

Since the start of open enrollment on Nov. 1, more than 160,000 individuals and families have already signed up for Qualified Health Plans (QHP) through Washington Healthplanfinder. The updated total reflects an increase of more than 20,000 QHP selections over the same point in the open enrollment period last year. In addition to 2017 QHP selections, more than 22,000 Washingtonians have signed up for Qualified Dental Plans (QDP) that are now offered through Washington Healthplanfinder.

Today, in an article about the overall national numbers (mainly noting today's Week 5/6 Snapshot report), Kimberly Leonard of U.S. News & World Report cited a number I haven't seen elsewhere; I presume she simply called up the exchange directly. It seems about right to me:

Open enrollment began a week before Election Day, and several states reported that they didn't begin running ads until after that, saying they didn't want to compete with the attention the election was getting and noting that space sold during that time was particularly expensive.

That was the choice for Colorado, where enrollment is 16.3 percent higher than last year, totalling 50,207 people.

In addition, Leonard provides a couple of quick updates/corrections for some other states:

Most states are as of 12/10/16 (officially the end of the 6th week, even though it's "short" 2 days due to November starting on a Tuesday this year)

The red vertical line is where I expected each state to be as of 12/10/16...around 38% of where I project their final projected enrollments to be as of 1/31/17

For purposes of this graph, I'm defining "ahead" or "behind" as being plus or minus 2 percentage points.

South Dakota, Hawaii, Minnesota, Utah, Nebraska, Oregon, Wyoming, Wisconsin, Florida, Kansas, Kentucky, Pennsylvania, Montana and Alabama are significantly ahead of where I expected them to be at this point.

On the other hand, New Hampshire, Michigan, Alaska, Georgia, Indiana, Texas, Arkansas, Colorado, Mississippi and especially Louisiana are all significantly behind so far.

...There's a simple reason for this: When I whipped up this year's Graph, I forgot to take into account that November 1st fell on a Tuesday this year instead of a Sunday. Since enrollments tend to drop off substantially on weekends, this means that the slowdown comes 2 days earlier each week. For most weeks this is barely visible on the Graph, but this week in particular it can make a huge difference...up to a couple hundred thousand people per day.

In addition, normally CMS officially adds several million auto-renewals in a big lump sum around December 17-18th. Since those dates also fall over the weekend this year, I'm assuming they'll all be plugged in at once on Monday the 19th, resulting in an even more dramatic vertical line shooting up on that date.

With these tweaks in mind, here's what The Graph now looks like. Again, I haven't changed my key deadline projections, just the day-to-day flow within the current week or so.

I don't write about dental plan coverage very often; the only time I've ever really talked about it at length was my angry rant at the HHS Dept. on November 20, 2014 after it was discovered that someone at HHS/CMS screwed up royally by mistakenly lumping in several hundred thousand standalone dental plan enrollments with the full Qualified Health Plan enrollments, falsely making it look like the effectuated enrollment was around 7.3 million people as of August when in fact the number had fallen below the 7.0 million mark.

Otherwise, I don't really talk about dental plans much. There's actually two ways people can sign up for dental plans via the ACA exchanges: Either as "enhanced" QHPs (ie, full healthcare policies which also bundle dental coverage with them...which all of them really should IMHO, seeing how your teeth and gums are part of your body, after all), or as separate, standalone plans which are optional (that is, you don't have to have dental coverage in order to meet the ACA's Individual Mandate requirement).

...HOWEVER, their bosses...the HHS Secretary and, I presume, the head of CMS...will be appointed by Donald J. Trump and confirmed by a 100% Republican-controlled Senate.

Given Trump's long, disturbing history of flat-out misstatements (aka "making sh*t up out of whole cloth"), and the type of sycophants he's likely to put into place, I can't guarantee with 100% certainty that the numbers spouted off by them are going to bear any connection with reality. Maybe they'll be accurate. Maybe they'll be off slightly. Maybe they'll be completely removed from any actual numbers. Who the hell knows?

Earlier today it was reported that Ben Carson was being considered for HHS Secretary. Then the rumor mill turned to Bobby Jindal. At the moment, I'm hearing it could be Rep. Tom Price, who (like pretty much every other GOP member of Congress) despises the ACA. That doesn't guarantee that he'll Make Sh*t Up, of course, but under a Trump regime, anything's possible. Anything.

“The deadline to have coverage starting the first of the year is this week,” said CEO Wadleigh. “We’re seeing huge numbers of people enrolling – which is amazing. We want people to have coverage, that’s for sure. But what we want most of all is for Connecticut to be healthy. We’re on the right track – we’ve seen over 16,000 people sign up for 2017 coverage since November 1st.”

On the one hand, only 14.5% of these are new, which is disturbingly low. On the other hand, part of the reason for this is because so many current enrollees actively renewed...helped, no doubt, by CoveredCA's new policy which allowed them to do so an entire month early (starting on October 1st).

Careful readers might notice a subtle but important change in The Graph today. Most of the key numbers (including both my 12/15 and 1/31 projections) remain the same (7.7 million and 13.8 million respectively), and the overall flow of the projection curve hasn't changed. However, there's a pretty obvious difference right in the middle of the graph...namely the current week (Week 7).

About 130,0000 Marylanders have signed up so far for insurance plans for 2017 through marylandhealthconnection.gov. Open enrollment began Nov. 1 and lasts through January, though people who want insurance starting Jan. 1 must be signed up by Thursday. About 163,000 people were enrolled in private plans this year, an increase of 33 percent from 2015.

The article was posted yesterday (12/12), so I assume the 130K figure is as of 12/11. I'm fairly certain that this includes auto-renewals, seeing how last year their 12/15 tally stood at 150K including all renewals (both passive and automatic).

It's difficult to do an exact apples to apples comparison, however, since enrollments should be ramping up dramatically during these final few days before the 12/15 deadline, so I'm not gonna try.

As they race to repeal large parts of the Affordable Care Act, President-elect Donald Trump and congressional Republicans are leaving behind nearly everyone but their base voters and a handful of conservative activists.

Not a single major organization representing patients, physicians, hospitals or others who work in the nation’s healthcare system backs the GOP’s Obamacare strategy.

New polls also show far more Americans would like to expand or keep the healthcare law, rather than repeal it.

Even many conservative health policy experts caution that the emerging Republican plan, which calls for a vote in January to roll back insurance coverage followed by a lengthy period to develop a replacement, could be disastrous.

He goes on to document just a handful of the organizations screaming from the rooftops what an utter disaster repealing the ACA without a reasonable replacement plan already in place would be:

The Republican Party already has their playbook for how to repeal the Affordable Care Act, cause massive disruption and damage to the healthcare market, kick potentially up to 29 million people off their healthcare coverage and get away with it by blaming it on the law itself (and, of course, President Obama). They're so certain that their plan will work that some of them are openly admitting the jaw-dropping chutzpah of it all:

That could lead to a mess for the roughly 10 million Americans currently getting coverage through the government-run marketplaces — and backlash against the GOP.

...But the enticements most likely to keep insurers in the exchanges are the ones in Obamacare that Republicans spent years denouncing as industry “bailouts” — subsidies that were supposed to insulate plans from big losses.

...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.

I haven't written a single word about Maryland since early October. Last year their ACA exchange was very good about posting fairly regular enrollment updates; this year they've been dead silent about it so far, which is rather surprising (and no, I don't think it's because their numbers are bad...every other state I have data for seems to be doing pretty well or even better than last year so far).

Anyway, there's one bit of news out of the Old Line State (yes, I had to look it up to find out what their nickname is) today which is disappointing but not surprising when you understand the circumstances:

The Maryland Insurance Administration barred Evergreen Health from selling health insurance policies for individuals until federal and state regulators decide whether to allow the cooperative to convert to a for-profit insurer and receive a much-needed cash infusion.

As of Dec. 6, we have 10,210 new plans selected, plus an additional 13,251 new enrollments. That’s a total of 23,461 new plans selected so far in Open Enrollment.

That doesn’t include an additional 3,291 plans selected or enrollments by “returning” members. These would be people who had Health Connector coverage at some point, but for whatever reason do not right now and are coming back for 2017.

OK, that's 26,752 new enrollees (I define "new" as anyone signing up who isn't already currently enrolled in an effectuated exchange policy, even if they used to be and dropped it a few months earlier). That's more than 3.5x as many as 3 weeks earlier; impressive.

"We’ll get to that next year," Ryan told reporters when asked how long the transition away from Obamacare would be. "We just had a meeting with all our authorizers this morning about working on this with the Senate and the transition team. Those talks are ongoing."

..."We’re going to have these kinds of conversations. I don’t have an opinion on exactly what that timeline will be," he said. "There’s a lot of moving parts, and we have a lot of dialogue that we have to have with just our friends in the Senate and with the White House on the transition. So it’s just premature to suggest that we know how exactly long this transition is."

Oh, good. I'm sure this will make all those healthcare actuaries feel better.

There's exactly 7 daysjust 3 days to go before the first major 2017 Open Enrollment Period deadline (the 12/15 deadline in most states for coverage starting January 1st), so let's see where things stand.

I've confirmed 2,903,199 QHP selections nationally, of which 2,137,717 are via the federal exchange and 765,482 are via the dozen state exchanges.

However, most of this only runs through November 26, and I still have no enrollment data at all for DC, Idaho, Maryland, New York, Vermont or Washington State.

I estimate that the actual national total broke through 4.5 million last night, and should break 5.0 million by tomorrow (Friday) night.

Enrollments should have started ramping up dramatically as we go into the final few days before the big 12/15 deadline, culminating in around 7.7 million by the 15th.

After that, the HC.gov auto-renewals should be tacked on somewhere around 12/17 - 12/18.

As recently as 11/26/16, enrollments on both the federal and most state exchanges was either pacing or somewhat ahead of my projections, with no "Trump Factor" to speak of. I won't know for sure whether this is still the case until the HC.gov Week 5-6 Snapshot report is released, which likely won't be until next Wednesday.

I've been posting so many stories about the ugly implications of the ACA being repealed that it's kind of nice to get back to actually reporting on the number of people enrolling for ACA coverage again (hey, it's right there in the title of this site and everything...)

Rhode Island, which issued regular weekly enrollment reports last year, has been unusually silent so far this year...until today:

HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, December 3, 2016 for Open Enrollment.

The nation’s hospital industry warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

The two main trade groups for U.S. hospitals dispatched a letter to the incoming president and Capitol Hill’s top four leaders, saying that the government should help hospitals avoid massive financial losses if the law is rescinded in a way that causes a surge of uninsured patients.

“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

As anyone who's visited the site the past few days knows, I've spent countless hours digging up data to find out exactly how many people are enrolled in Medicaid/CHIP specifically due to the ACA's expansion provision. This is much more difficult than you'd think for a variety of reasons. For one thing, each state seems to have different methodology for how they track and report Medicaid enrollees (some weekly, some monthly, some quarterly, etc). For another, there's a wide variety of eligibility thresholds under pre-ACA Medicaid for different groups of residents in each state (pregnant women, infants, children, parents, etc), and since the funding mechanism varies depending on whether the enrollee qualifies for "normal" Medicaid or "ACA expansion" Medicaid, categorization can be tricky. Finally, due to the churn factor (people moving up and down the income scale as well as gaining or losing job-based or other forms of coverage), the numbers can jump around from month to month or even week to week.

Earlier today I posted fully broken-down estimates of just how many people would be directly impacted by a full & repeal of the Affordable Care Act this spring, assuming that the repeal took immediate effect and there was no replacement plan in place for the various provisions of the law.

The largest single category of enrollees in my estimates are those enrolled in Medicaid/CHIP due specifically to the ACA's Medicaid expansion provision. I estimated this to be roughly 11.3 million people nationally.

01/12/17: PLEASE NOTE: I know there's a whole bunch of updates/revisions below; this is because I'm constantly updating both the Medicaid expansion and exchange policy numbers daily, in real time as I'm able to compile the most recent enrollment numbers. In most cases the numbers are quietly increasing, although in a few cases I've revised them downward.

I operate this site by myself and I do have a day job, family, etc, so if I haven't updated your state, be assured I'll get to it as soon as possible.

Now that we're past Thanksgiving weekend and the big December 15th deadline (for January coverage) is coming up fast, OE4 enrollments should have started ramping up significantly, on the order of 250,000 per day or more nationally (around 190K via HC.gov).

The Connecticut ACA exchange, AccessHealthCT, issued a press release today reminding Connecticut residents in general of the December 15th deadline for January 1st coverage. They also stressed, however, that while most current enrollees will be automatically renewed into either their existing policy, there are about 26,000 current enrollees who can't be auto-renewed because their carrier is leaving the exchange in 2017:

On December 1st, AHCT’s automatic renewal process began. The AHCT eligibility system will automatically enroll into 2017 coverage customers who have selected auto-renew and whose plans are still available. “But, there are 26,000 people who currently have coverage through AHCT who cannot auto-renew and must take action to renew their 2017 plans,” Wadleigh noted. Wadleigh reminds all customers “they should shop around and compare your options for 2017– that’s the purpose of the marketplace.”

DENVER — More than 37,000 Coloradans selected healthcare coverage for 2017 through the state health insurance Marketplace in November, a rate 23 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®.

“The pace of sign-ups during the first month of this Open Enrollment has been very heartening,” said Connect for Health Colorado CEO Kevin Patterson. “We know that there is a lot of discussion now about the future direction of healthcare, but what remains constant and true is the importance of protecting the health and financial future of all Coloradans. I encourage everyone who needs health insurance to check to see if they qualify for financial assistance, review the available plans, and complete an enrollment before the last-minute rush.”

In the first month of the annual Open Enrollment period, Coloradans selected 37,948 medical and dental insurance plans. That compares to 30,777 such plan selections in November 2015.